Health care talks fall apart

The negotiations between House Energy and Commerce Chairman Henry Waxman (D-Calif.) and seven conservative Democrats on his panel fell apart Friday afternoon after the chairman told reporters he might bypass his committee and take the health care bill straight to the floor.

But this setback in committee may set the stage for a House vote next week on the sweeping health legislation — a prospect that would help President Barack Obama meet his August deadline in the House, but one that divides Democrats as the tense intra-party negotiations continue.

Bypassing the committee may also cost Waxman and Democratic leaders the votes of many moderate Democrats.

Arkansas Rep. Mike Ross, the top negotiator for conservative Democrats in the 52-member Blue Dog Coalition, told reporters Friday that the negotiations "pretty much fell apart this afternoon."

The finger-pointing commenced shortly afterward, with Melancon believing he'd been lied to while Waxman complaining that "some Democrats would rather align with the Republicans."

The breakdown came in a Friday negotiating session after a broad swath of Democrats agreed to iron out regional disparities in Medicare reimbursement rates, a compromise that attracts more lawmakers to the bill.

Asked how this leaves negotiations, Ross said it "leaves the chairman with not enough votes to get it out of committee."

During the session, Waxman rescinded a tentative agreement to include language in the bill that would allow doctors and other health care providers to negotiate their rates with a government-sponsored coverage plan created by the legislation. The Blue Dogs also came away with the impression that Waxman had withdrawn a White House proposal to empower an outside commission with the authority to cut government-funded health care costs, but the chairman said that plan was still on the table.

Shortly afterward, Waxman and the other Democrats on the committee retired to a closed-door meeting in the Rayburn House Office Building to decide whether to proceed straight to the floor.

"We're either the majority party and work together," Waxman told reporters afterward, "or we're not."

But Blue Dogs complained that Waxman and the administration hadn't been negotiating in good faith — despite a three-hour session at the White House earlier this week and another three-hour session with party leaders and presidential Chief of Staff Rahm Emanuel.

Waxman's threat earlier in the day to circumvent the committee riled these moderates who believed they were making real progress.

"The statement was not very helpful at all," Ross told a crowd of reporters just off the House floor.

The deal on regional disparities in the Medicare reimbursement rates calls for a comprehensive study to iron out any inequities. A separate study would also explore over-utilization of specialized medicine, something the White House and congressional Democrats have highlighted as a major factor in the rapid acceleration of health care costs. Lawmakers reached that agreement after hours of tense, often heated, negotiations.

In light of that change, Waxman said it would be unnecessary for doctors and health care providers to negotiate their rates with the government. Instead, Waxman reverted to his original plan that would use a multiple of the existing rates — something Blue Dogs and others had highlighted early as a major problem with the plan.

The question now is whether the White House and party leaders will agree to move the House bill before members leave for the August recess, even if a big wing of the party still has problems with the legislation.

Circumventing the Energy and Commerce Committee would be a major departure from the Democrats' campaign pledge to run a more transparent, open Congress than their Republican predecessors, and a top Democratic leader pushed back on the idea.

"I would love to us follow the regular order in doing this,” said Majority Whip Jim Clyburn (D-S.C.). “Two weeks ago, I said I wanted us to do this in such a way that we'll have ample time."

In an interview on WTOP on Friday, Maryland Rep. Chris Van Hollen, who chairs the party's campaign arm in the House, said it "would be a mistake" to avoid a vote on the Energy and Commerce Committee. And aides tamped down that speculation Thursday night.

But Clyburn, who would like to extend the session to move a bill, admitted that there was great political pressure to act before August, because he doesn’t want people to think Congress couldn’t get something done and then went on vacation.

Moving without the Blue Dogs could be hard. On Friday, Melancon guessed somewhere between 40 and 45 members of the group would vote against it - more than enough to kill it, if Republicans unanimously oppose the reform measure.

The study on over-utilization could pre-empt the White House plan to task an outside commission with finding cuts in current government-funded health care programs.

Whether or not party leaders decide to pursue a vote next week, Democrats will huddle all day Monday to walk through the bill in explicit detail. The House will also consider a measure to fund the Department of Defense, according to a notification sent out Friday from the Committee on Rules, giving Democrats some cover if they don't move the health care bill.